The ANSC GP Resource Manual is intended as a guide for general practitioners participating in the SLHD Antenatal Shared Care Program. The manual content is closely linked with HealthPathways where clinically relevant.

pdf ANSC GP Resource Manual v 7.4 (9.11 MB)  (June 2017)

GPs participating in the ANSC program will be expected to adhere to the agreed guidelines as outlined in the SLHD ANSC Protocol when caring for their antenatal shared care patients.

pdf SLHD Antenatal Shared Care Protocol (250 KB)

Breaches of the ANSC Protocol that affect patient outcomes will be recorded for quality assurance purposes. Any investigations requested by the GP for a woman under his/her care must be followed up by the GP concerned. At all times it is the primary responsibility of the provider ordering the test or noting an abnormal finding to ensure appropriate follow-up management and communication, irrespective of whether a copy has been sent to the participating hospital. 

pdf SLHD Breastfeeding Policy Compliance Procedure 2017 (3.01 MB) : Comprehensive breastfeeding guidelines and information
 Search for a Certified Lactation Consultant: Lactation Consultants Association of Australia and New Zealand (LCANZ)

Patient information and resources

 SLHD Early Childhood Services
Child and Family Health: all referrals/enquiries to local Early Childhood Centres is via the Central Intake Line (Phone: 9562 5400)

 Australian Breastfeeding Association (ABA)

Infant Feeding Guidelines

 NHMRC Infant Feeding Guidelines - comprehensive guidelines for health workers recommending breastfeeding and infant feeding

The aim of EPAS is to identify and manage ectopic pregnancies, vaginal bleeding in pregnancy, or miscarriage < 20 weeks gestation.

Contact Gynaecology Registrar on call for all pregnant patients <20 weeks who need urgent review or for a woman being sent to the Emergency Department. (If > 20 week’s gestation women should be sent to the Delivery Ward – after contacting the O&G Registrar)

The EPAS service is available to assist you with the management of your haemodynamically stable patient.

Where

RPA Woman and Babies Womens Ambulatory Care - Level 5

Clinic time

7.30 am (ONLY) Mon - Fri excluding public holidays (no appointments)

Must bring

pdf EPAS Referral Form (432 KB) , completed by GP. Copy of Blood Group, serum quantitative BHCG, previous ultrasound report.

Who to refer

Pregnant women (less than 20 weeks gestation) who are bleeding and/or have pain BUT are haemodynamically stable.

Enquiries

Phone: 9515 7101 or Fax: 9515 7452
Clinical Midwifery Consultant (CMC) Mon - Sun Phone: RPA: 9515 6111, Pager: #87403

Important information

• Do not send patient’s to ED or EPAS for Anti D without a pathology copy of their Blood Group.
• Do not send women to EPAS for a termination of pregnancy.
• Do not send women for a dating scan to ED, EPAS or Fetal Medicine Unit.
• Do not send women to EPAS for management of hyperemesis.
• Advise women she will be assessed by either Doctor or Midwife Consultant and may have blood tests and/or a vaginal ultrasound so will NOT need a full bladder. This is a very busy service and waiting times may vary, patience is required.

Regular enquiry about fetal movements is an important aspect of ascertaining fetal wellbeing.

Decreased fetal movements in the third trimester: Guidelines - Ministry of Health NSW
 PSANZ Stillbirth and Neonatal Death Alliance - Resources for both health professionals and women

  pdf First Trimester Pregnancy Information Kit (3.31 MB)  (July 2017 ) - Early pregnancy information for GPs who may not be actively participating in the ANSC Program

Healthy eating during pregnancy

 NSW Health "Get Healthy in pregnancy" - services including free counselling service,information and resources regarding physical activity, healthy eating and weight gain 
 NSW Health " Get Healthy" Service " - a range of resources developed to assist GPs and AHPs to promote the "Get Healthy" service
 NSW Health " Get Healthy General Practice Referral Form" + additional referral information. The General Practice Referal Form template is already supplied in both Medical Director and Best Practice ( For BP, tick ALL STATES box) 

Healthy eating when you're pregnant or breastfeeding: patient information - Department of Health
 Food safety during pregnancy - NSW Food Authority

Pregnancy and alcohol

 Women want to know: Discussing pregnancy and alcohol - Department of Health project providing assessment tools and information for health professionals. 

Smoking Cessation Clinics

Drug Health Services offer one-to-one counselling support clinics for individuals wishing to stop smoking. Clinics are located at RPA ph. 9515 7611 (Wed 1.00-4.00pm, Thurs 1.00-4.00pm)  and Croydon Community Health Centre ph. 9378 1306 (Mon 9.00-2.30pm)

Management of Obesity

RANZCOG College Statement: Management of obesity in pregnancy
NSW Health "Get Healthy in pregnancy" - services including free counselling service, information and resources regarding physical activity, healthy eating and weight gain

Oral Health

Oral health during pregnancy: Patient information

  pdf Diagnostic Testing for Hyperglycaemia in pregnancy (504 KB) (April 2016) - Includes defining risk, screening protocol, interpreting results, postnatal follow-up and pre-pregnancy assessment
  pdf Glucose Tolerance Test (GTT) Instructions (149 KB)
Hyperglycaemia - HealthPathways Sydney
 ADIPS - Australian Diabetes In Pregnancy Society- Resources for both health professionals and patients
pdf Canterbury Hospital "Too long to wait" Clinical Redesign Project newsletter (1015 KB) - Aimimg to improve the quality and continuity of care provided to women with Gestational Diabetes (GDM) or Type 2 diabetes (T2D) in the ANC and primary health care setting.

Overdue pregnancies

Following the 40 week GP visit, advise patients to contact the clinic for their post dates appointment.

Women need to be seen at 41 weeks +1 day in the Registrars' "Post Dates" clinic. Should this date fall on a weekend the women must be seen in the previous Thursday afternoon.

Should they go into labour there is no need to call and cancel the clinic appointment.

Along with routine assessment an internal (P.V.) examination will be attended. A management plan for induction of labour will be determined based on the findings. These will be fully discussed with the woman. Instructions, information and a planned date for their hospital admission will be given.

  pdf RPA Women and Babies/Canterbury Hospital Antenatal Shared Care Program (9.76 MB) - Patient information
 RPA: Your breech baby - Patient information
 RPA: Women having an External Cephalic Version (ECV) - Patient information
 Vaginal Birth After Caesarean (VBAC) Labour Care - Patient information
 Previous Caesarean - Patient information

pdf SLHD Pelvic Pain in pregnancy (259 KB)  - Patient information

  pdf Nausea and vomiting in preganancy information (70 KB)  - RPA Emergency Department 
  pdf Hyperemesis: Clinical Practice Guideline  (127 KB) - RPA Emergency Department 

 beyondblue - provides access to a variety of information regarding perinatal mental health
Black Dog Institute - organisation dedicated to understanding, preventing and treating mental illness 
Edinburgh Postnatal Depression Scale (EPDS)- assessment of perinatal depressive illness-Black Dog Institute 
  pdf Translated Edinburgh Postnatal Depression Scale (EPDS) (4.00 MB)  
  pdf Mental Health Care in the Perinatal Period - Australian Clinical Practice Guideline (681 KB)  - Centre of Perinatal Excellence (COPE)
Depression during pregnancy and postnatal - Black Dog Institute
Postnatal Risk Questionnaire - Black Dog Institute
  pdf Looking after your perinatal mental health (611 KB) - Information for conumers
  pdf Perinatal mental health EPDS + ANRQ Screening Tools (611 KB)

Pre-pregnancy counselling is an important and integral part of any woman’s health care if she is planning a pregnancy. It is recognised that situations may require specialist advice including an obstetrician, geneticist or paediatrician.

  pdf RPA Pregnancy Planning Clinic (560 KB)  - new multidiscipline service providing comprehensive assessment of preconception health for women and/or couples planning a pregnancy
 Preconception checklist - areas for discussion and referrals (if required) prior to pregnancy

The Fetal Medicine Unit at RPA Women and Babies routinely offers Combined First Trimester Screening (cFTS): ultrasound scan (nuchal translucency and nasal bone) plus biochemistry to pregnant women booking for delivery at RPA Women and Babies and Canterbury Hospitals.

Access to Non-Invasive Prenatal Testing (NIPT) will be as a second line screening tool (contingent model flowchart), for women at high or intermediate level of risk after cFTS. The NIPT test is not available through Medicare and women will have to fund this test themselves. For further information contact the RPA Genetic Counsellors ph 9515 5080 or Fetal Medicine Unit ph 9515 6042

Antenatal Shared Care GPs can refer women directly to the Fetal Medicine Unit (Phone: 9515 6042 or Fax: 9515 6579) for the following tests:

• Combined First Trimester Screening (cFTS)
• Non-Invasive Prenatal Screening (NIPT)
• Chrorionic Villus Sampling (CVS)
• Aminocentesis

Resources

Screening tests for your baby in early pregnancy (Patient Information Pamphlet) : NSW Centre for Genetics 
 Prenatal testing booklet ( Patient Information Pamphlet):  NSW Health Centre for Genetics Education
pdf RPA cFTS (Patient Information Pamphlet)  (285 KB)
pdf RPA NIPT ( Patient Information Pamphlet) (324 KB)
 First Trimester Sceening Learning Module: NSW Centre For Genetics: On-line education module 
  pdf Prenatal screening "flipchart" resource (1.89 MB)  
Search for Certified Operators to perform Nuchal Translucency - RANZCOG Nuchal Translucency: Ultrasound, education and monitoring program

Additional information on a range of genetic matters can be accessed from the NSW Health Centre for Genetics Education and the National Health and Medical Research Council - NHMRC.

Translated material regarding genetics, prenatal testing and pregnancy are located at the Multicultural Health Communication Service - NSW Health.

  pdf Thyroid Disease Guidelines (274 KB) : Who to screen, Thyroid Function Test Reference ranges in pregnancy, Referral criteria
pdf Referral Flowchart - Antenatal Thyroid Clinic
(14 KB)  Thyroid Disease in pregnancy- HealthPathways Sydney pdf
(14 KB)

Translated material regarding pregnancy related issues can be located at NSW Health: Multicultural Health Communication Sevice. Information available include maternity care options, planning a pregnancy, caring for a baby at home and depression during pregnancy and early parenthood.

Prevaccination Infomation

• Prevaccination information is available in the The Australian Immunisation Handbook, 10th edition (Section 2.1)
• Prevaccination Checklist
  
  

Influenza

Administration of the influenza vaccination should be at the GP visit and documented on the antenatal "yellow card" next to "Investigations" or circle Y/N if card is stamped with "Flu Vax". The influenza vaccination is available free to pregnant women.

Influenza vaccination during pregnancy

Vaccination remains the best protection pregnant women and their newborn babies have against influenza. 

Despite influenza vaccination being available free to pregnant women on the National Immunisation Program, vaccination rates remain low with only 1 in 3 pregnant women receiving the influenza vaccine.  Influenza infection during pregnancy can lead to premature delivery and even death in newborns and very young babies. Pregnant women can have the vaccine at any time during pregnancy and they benefit from it all through the year. 

Three educational videos are available:  

Flu vaccination and pregnancy – Free flu shots for pregnant women ​(for health care professionals)
Flu vaccination and pregnancy – What pregnant women need to know​ (for pregnant women)
Flu vaccination and pregnancy – Vaccinate against flu Protect your baby too​ (for pregnant women)

For further information visit:
 Immunise Australia Pregnant Women ​
 NSW Health Seasonal Influenza Vaccination 2017
RANZCOG College Statement: Influenza vaccination during pregnancy
Influenza Vaccination in Pregnancy and Breastfeeding: Mothersafe factsheets - Patient information

Pertussis

NSW Health has introduced an antenatal pertussis vaccination program to offer free Boostrix vaccine to all pregnant women in the third trimester (preferably at 28 weeks).

The free whooping cough vaccine during pregnancy is the best way to protect newborns from day one with studies showing that it is more than 90 per cent effective in preventing whooping cough in infants.

  pdf Antenatal Pertussis Vaccination: GP & AMS Information (46 KB)
  pdf Antenatal Pertussis Vaccination: Evidence Review (573 KB)
  pdf Antenatal Pertussis Vaccination: Consumer Factsheet (503 KB)
  pdf Antenatal Pertussis Vaccination: Consumer Information (A5 pad) (757 KB)
 Immunisation Handbook: Pertussis update
 Protect newborns from whooping cough - NSW Health